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The mortality for uveal melanoma remains high because of the development of metastatic disease, predominantly in the liver, that almost invariably is refractory to therapy. A potentially effective strategy would be to suppress micrometastases before they progress. Systemic therapy may be more effective in the adjuvant setting treating micro- rather than macrometastatic disease, where several mechanisms of resistance can develop. Likewise, the earlier detection of metastatic disease may potentially increase the effectiveness of already-existing therapies. Liver-function tests are routinely used to detect asymptomatic liver metastasis. In patients with uveal melanoma, they have high specificity and predictive values but a very low sensitivity.1 Genotyping of the primary tumour can identify patients with uveal melanoma at high risk for metastasis and is becoming increasingly applied clinically.2 The time from diagnosis of the primary to discovery of metastasis can range from weeks to decades. Assessment of tumour tissue does not indicate whether tumour cells have actually been shed and forming metastasis, and it cannot indicate whether treatment is reducing metastasis. Blood biomarkers of uveal melanoma metastasis are needed. …
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